Racial Disparities Linger in Disease Prevention

Black History Month is an opportunity to reflect on how far America and the African-American community has come, and how much more we have to accomplish. Consider the field of health care. As the U.S. Department of Health & Human Services’ Office of Minority Health said last year, “Although black people have continued to make strides and shape the United States, health rates on average for chronic diseases, infections and death have taken a toll on the population.”

True, some health issues are linked to personal responsibility, such as diet and exercise. Yet other health issues in our community are impacted by the decisions of others – and it is these issues that we must work to correct.

Everyone knows that infants are uniquely susceptible to infections, and premature babies are especially vulnerable as their lungs are still developing. In addition, many have not yet acquired all of their mothers’ antibodies. This time of year, that puts them at greater risk of catching diseases such as respiratory syncytial virus (RSV), a common childhood infection, and increases the risk of serious illness and hospitalization.

Take note: RSV has a disproportionate impact on the African-American community. In the words of Debra A. Toney, president of the National Black Nurses Association, “Not only are African Americans over-represented among infants who are premature and/or low birth weight, they are also over-represented within the ranks of almost all other RSV risk factors.”

Serious illness and hospitalizations are sometimes terrifying (and all too often expensive) for parents. While no vaccine exists to completely protect against RSV, preventative treatment options do exist, alleviating worry and greater expense down the road.

Unfortunately, it’s become increasingly difficult for families to access these treatments due to a change by the American Association of Pediatrics (AAP) in their “Red Book,” a compilation of best practices and treatment guidelines for pediatricians. Reports have indicated that since 2009, the AAP has limited both the number of infants who are eligible for RSV prophylaxis, as well as the number of treatments that babies can receive – a reduction based not on science, but on “cost.”

The AAP’s guidelines are widely used by private insurance companies, as well as by Medicaid. Accordingly, what’s in there is what is covered – so when the AAP restricts coverage of RSV treatments, unintended consequence occur such as some insurance companies restricting their coverage.

Families with money, of course, can pay out of pocket for the preventative treatment if they’re turned down by their insurance company. Those without a few thousand dollars to spare, however, don’t have that luxury, and have to cross their fingers that their child’s case of RSV doesn’t become severe. In effect, we’ve created a two-tiered health care system.

Think about it: we’re trying to save health care dollars on the backs of defenseless infants. Is this the kind of health care system that our premature babies deserve?

Three weeks ago, the National Medical Association, the nation’s oldest and largest organization of African-American physicians, issued a press release about the AAP guidelines, asserting “We cannot continue to experiment with our infants or support ‘off-label’ treatment via decreasing the length of treatment and dosing. The NMA will continue to advocate for increased research and demands the recommended duration of treatment be based on substantial clinical trials and thus scientific evidence.”

This is not the first time the NMA has raised this issue. Two years ago, it issued a detailed, thoroughly researched consensus report on the disease and its impact on minority communities. Still, this issue has yet to reach the level of serious dialogue.

Perhaps Black History Month will remind us all to stay engaged in this issue. It would only be appropriate to consider the NMA’s recommendations as we work to improve the health of African Americans.

Ron Dellums is a former U.S. Representative from California and former mayor of Oakland, Calif.